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Presentation Details
| Importance of Anticoagulation Clinics in Identification of Antiphospholipid Antibody Syndrome Misclassification Deborah Gillard1, Lisa Baumann Kreuziger1, 2, 3, Jennifer Hardman1. 1Froedtert Health, Milwaukee, WI, USA.2Medical College of Wisconsin, Milwaukee, WI, USA.3Versiti Blood Research Institute, Milwaukee, WI, USA |
Abstract
Background: Accurate diagnosis of antiphospholipid antibody syndrome (APS) is essential to warfarin management because APS is considered a high thrombotic risk factor, and these patients may require bridging with low molecular weight heparin (LMWH) during warfarin interruptions. Switching to a direct oral anticoagulant could also occur if a diagnosis of APS is ruled out. The Froedtert Health Anticoagulation Clinic is a system-wide, multisite clinic within an academic health system which manages approximately 3100 warfarin patients, which is essentially all of the patients prescribed warfarin by a Froedtert Health provider. Objectives: The intent of this project is to ensure that all patients with APS are accurately identified within our health system. Methods: An electronic medical record report was created to identify all warfarin patients actively managed by the Froedtert Health Anticoagulation Clinic who also had a diagnosis on their problem list or past medical history of APS, lupus anticoagulant disorder, anticardiolipin antibody syndrome or Beta-2 glycoprotein antibody. Laboratory data and thrombosis history was extracted from internal and external sources by chart review. Charts of patients who met Sapporo criteria for APS were left unchanged. If adequate data ruled out APS, we placed a note in their chart and related diagnosis was resolved from their problem list. Patients who required additional testing to confirm APS diagnosis were contacted and appropriate labs were ordered. Charts were then updated as appropriate based on lab results. Next steps include additional screening for patients who may be candidates for switch to a DOAC medication. Results: In total, 101/154 (66%) patients met criteria for APS diagnosis and 19/154 (12%) did not meet criteria for APS by chart review. Additional testing was needed in 34/154 (22%) patients. To date, 7/34 patients with additional testing had APS ruled out, 13/34 patients have had APS confirmed, and 14 patients have testing pending. Conclusions: Diagnosis of APS is complicated due to need for repeat laboratory testing but has implications for anticoagulation management. As noted in another published report, an initiative to confirm accurate APS diagnosis reinforces the benefit of anticoagulation stewardship within a health system. In collaboration with referring providers, Anticoagulation Clinics play an important role to ensure accurate APS diagnosis.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.